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10.1146/annurev.physiol.68.040504.094635

Annu. Rev. Physiol. 2006. 68:279–305

doi: 10.1146/annurev.physiol.68.040504.094635
Copyright c 2006 by Annual Reviews. All rights reserved
First published online as a Review in Advance on September 28, 2005

BRAINSTEM CIRCUITS REGULATING GASTRIC

FUNCTION
R. Alberto Travagli, Gerlinda E. Hermann,
Kirsteen N. Browning, and Richard C. Rogers
Department of Neuroscience, Pennington Biomedical Research Center, Louisiana State
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

University System, Baton Rouge, Louisiana 70808; email: travagra@pbrc.edu,

by Lomonosov Moscow State University on 02/10/14. For personal use only.

hermange@pbrc.edu, brownik@pbrc.edu, rogersrc@pbrc.edu

Key Words dorsal motor nucleus of the vagus, nucleus tractus solitarius,
gastrointestinal reflexes, plasticity
Abstract Brainstem parasympathetic circuits that modulate digestive functions of
the stomach are comprised of afferent vagal fibers, neurons of the nucleus tractus soli-
tarius (NTS), and the efferent fibers originating in the dorsal motor nucleus of the vagus
(DMV). A large body of evidence has shown that neuronal communications between
the NTS and the DMV are plastic and are regulated by the presence of a variety of
neurotransmitters and circulating hormones as well as the presence, or absence, of
afferent input to the NTS. These data suggest that descending central nervous system
inputs as well as hormonal and afferent feedback resulting from the digestive process
can powerfully regulate vago-vagal reflex sensitivity. This paper first reviews the es-
sential “static” organization and function of vago-vagal gastric control neurocircuitry.
We then present data on the opioidergic modulation of NTS connections with the DMV
as an example of the “gating” of these reflexes, i.e., how neurotransmitters, hormones,
and vagal afferent traffic can make an otherwise static autonomic reflex highly plastic.

OVERVIEW
The gastrointestinal (GI) tract possesses an intrinsic nervous plexus that allows
the intestine to have a considerable degree of independent neural control. The
stomach and the esophagus, however, are almost completely dependent upon ex-
trinsic nervous inputs arising from the central nervous system (CNS) (1–6). CNS
control over the smooth and coordinated digestive functions of the stomach is me-
diated by parasympathetic and sympathetic pathways that either originate in, or
are controlled by, neural circuits in the caudal brainstem.
Sympathetic control of the stomach stems from cholinergic preganglionic neu-
rons in the intermediolateral column of the thoracic spinal cord (T6 through T9
divisions), which impinge on postganglionic neurons in the celiac ganglion, of
which the catecholaminergic neurons provide the stomach with most of its sym-
pathetic supply. Sympathetic regulation of motility primarily involves inhibitory
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280 TRAVAGLI ET AL.

presynaptic modulation of vagal cholinergic input to postganglionic neurons in

the enteric plexus. The magnitude of sympathetic inhibition of motility is directly
proportional to the level of background vagal efferent input (7). Recognizing that
the GI tract is under the dual control of the sympathetic and parasympathetic ner-
vous systems, we refer the reader to other comprehensive reviews on the role of the
sympathetic control of gastric function (7–9). The present review focuses on the
functionally dominant parasympathetic control of the stomach via the dorsal motor
nucleus of the vagus (DMV) and the means by which this input is modulated, i.e.,
plasticity of vago-vagal reflexes.
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ORGANIZATION OF THE BRAINSTEM VAGAL CIRCUITS

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CONTROLLING THE STOMACH

Visceral Afferent Inputs to Brainstem Gastric Control Circuits

Vagal afferent fibers carry a large volume of information about the physiological
status of the gut directly to brainstem circuits regulating gastric function. The cell
bodies of origin for this afferent sensory pathway are contained in the nodose
ganglion. Neurons in the nodose ganglia are the cranial equivalent of dorsal root
ganglion cells in that they are bipolar and connect the gut directly with nucleus
tractus solitarius (NTS) neurons in the brainstem with no intervening synapse
(reviewed recently in References 10–13).
There are several types of visceral receptors and afferent fibers (7, 9, 14–31).
Independent of their functions or modalities, however, all vagal afferents use glu-
tamate as the primary neurotransmitter to transfer information to the NTS (32–42).
Electrophysiological experiments have shown that glutamate released onto pre-
sumptive GI NTS neurons activates both NMDA and non-NMDA receptors (35,
41, 43), as do putative cardiovascular NTS neurons (36, 44, 45). The release of
glutamate at this interface between peripheral perception (sensory afferent fibers)
and central integration (NTS neurons) is open to modulation by a wide variety of
transmitter and hormonal agonists, including glutamate itself (46–51), cholecys-
tokinin (CCK) (52–54), leptin (55, 56), tumor necrosis factor (57), and ATP (58),
to name but a few. These data strongly suggest that vago-vagal reflex functions are
subject to pre- as well as postsynaptic modulation.

Nucleus Tractus Solitarius

The general hypothesis of a vago-vagal reflex connecting vagal afferent input,
brainstem NTS neurons, and vagal efferent projections to the stomach was for-
mulated some years ago and has been reviewed extensively (6, 10, 38, 59–66).
The early models presented a framework to explain many of the salient features
of brainstem reflex control of the stomach. Simply put, reflex action is initiated
by stimulation of sensory vagal afferent pathways, which activate second-order
NTS neurons via glutamate action on NMDA and non-NMDA receptors. These
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VAGAL CONTROL OF THE GI TRACT 281

NTS neurons can use several different neurotransmitters to control the output from
DMV cells, which, in turn, control gastric functions and complete the vago-vagal
loop (Figure 1).
Visceral sensory afferents are organized in an overlapping topographic manner
within the NTS subnuclei. Terminal fields from the intestine are represented in the
subnuclei commissuralis and medialis, the stomach sends its afferent inputs to the
subnuclei medialis and gelatinosus, and the esophagus to the subnucleus centralis
(66–70).
Although sensory inputs from distinct visceral areas, such as, for example,
the aortic branches or gastric branches, do not seem to converge on single NTS
neurons (71), the same subnucleus receives sensory information from more than
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one peripheral organ. Afferent terminals involved in arterial baroreflex circuits as

by Lomonosov Moscow State University on 02/10/14. For personal use only.

well as terminals involved in vago-vagal gastric reflexes, for example, impinge

upon neurons similarly located in the subnucleus medialis of the NTS (17, 38, 67,
70, 72–76). This overlap of the terminal fields from different organs within the NTS
makes the anatomical and functional identification of individual neurons difficult.
The subnucleus centralis (cNTS), however, provides a convenient exception
in that it seems to receive inputs from vagal afferent fibers originating almost
exclusively in the esophagus (17, 38, 66, 67, 77), making it an excellent model
for the study of a population of second-order neurons controlling esophageal-
mediated reflexes. The cNTS of the rat is located between the tractus solitarius
and the lateral third of the DMV at a level of approximately 0.5 to 1.5 mm rostral
to the calamus scriptorius (70). Note that although the cNTS projects to the DMV
as part of a classic example of a vago-vagal reflex, it also projects to areas that
are not related to CNS control of gastric functions. Indeed, the cNTS projects to
the nucleus ambiguus (NAmb), the reticular formation, and the ependymal layer
of the fourth ventricle, as well as other NTS subnuclei (66). Thus, although cNTS
neurons receive sensory information almost exclusively from the esophagus, these
neurons control outputs related to gastric, esophageal, cardiovascular, deglutitive,
and respiratory functions. Neurons of the cNTS may also be subject to plastic
changes in function that translate into dramatic shifts in the reflex responses to
afferent input dependent upon, and appropriate to, the feeding status of the animal.

Dorsal Motor Nucleus of the Vagus

The parasympathetic motor supply to the stomach is provided by the efferent
vagus nerve originating from neurons located in the NAmb and DMV. The NAmb
contains the soma of cells contributing to the vagal control of the esophagus, upper
esophageal sphincter, and cardiorespiratory system. We refer the reader to recent
reviews dealing with the NAmb (6, 8, 63, 77, 78).
The cell bodies for the great majority of parasympathetic efferent fibers that
project to the upper GI tract originate along the whole rostro-caudal extent of
the DMV (79–81). The DMV is a paired structure in the dorsal caudal medulla
adjacent to the central canal, the majority of whose cells project to neurons in
the myenteric plexus or onto interstitial cells of Cajal (ICC) of the upper GI tract
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282 TRAVAGLI ET AL.

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Figure 1 Cytoarchitecture of the dorsal vagal complex. Darkfield photomicrograph of a

coronal section of rat brainstem at the level of the area postrema/intermediate level following
application of HRP crystals to the subdiaphragmatic vagus. Note the intense labeling of the
nucleus tractus solitarius (NTS), dorsal motor nucleus of the vagus (DMV), and nucleus
ambiguus (NAmb). An area of the photomicrograph (dotted line) has been expanded into
cartoon form to allow a more detailed illustration of the brainstem circuitry of gastrointestinal
(GI) vago-vagal reflexes. Note that vagal afferent neurons, whose cell bodies lie in the nodose
ganglion, receive sensations from the GI tract. The central terminals of these afferent fibers
enter the brainstem via the tractus solitarius and terminate within the NTS, utilizing principally
glutamate as their neurotransmitter. These afferent signals are integrated by neurons of the
NTS that project to, among other areas, the adjacent DMV using, mainly, glutamate, GABA,
or NE as neurotransmitters. Neurons of the DMV are the preganglionic parasympathetic
motoneurons that provide the motor output to the GI tract via the efferent vagus, where
they release acetylcholine onto their postganglionic target. Postganglionic parasympathetic
neurons are either excitatory [cholinergic (ACh)] or inhibitory [nonadrenergic, noncholinergic
(NANC)].
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VAGAL CONTROL OF THE GI TRACT 283

(19, 82–85), with the highest density of efferent fibers terminating in the stomach
(87).
Retrograde tracing experiments have determined that the DMV is organized in
medio-lateral columns spanning its rostro-caudal extent (79–81). Efferent projec-
tions originating from soma located in the medial portions of the nucleus form
both the dorsal and ventral gastric vagal branches. Neurons in the lateral portions
of the DMV send axons to the vagal celiac and accessory celiac branches, whereas
scattered neurons in the left DMV provide axons to the hepatic branch. The medio-
lateral organization of the columns is not maintained when the target organs of the
various vagal branches are considered. In fact, the two gastric branches innervate
the stomach, a portion of the proximal duodenum, and some visceral structures
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such as the pancreas; the celiac branches innervate the GI tract from the duodenum
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to the transverse colon; and the hepatic branch innervates parts of the stomach,
liver, and proximal duodenum (87, 88).
Although the DMV may not be organized in a rigid organotypic manner, ev-
idence suggests that the vagal innervation of the stomach is segregated within
the DMV by function. For example, descending vagal pathways responsible for
causing gastric contractions versus gastric relaxation [i.e., the nonadrenergic, non-
cholinergic (NANC) pathway] appear to be localized in different regions of the
DMV. That is, putative NANC-pathway neurons appear to be located in the cau-
domedial and rostrolateral divisions of the DMV, whereas the gastroexcitatory
neurons are located in the more rostral and medial divisions of the DMV (66, 89).
The DMV is comprised of neuronal populations that are nonhomogeneous with
respect to morphological features such as soma size and shape, number of dendritic
branches, and extent of dendritic arborization (90–96). The significance of these
morphological differences is not well understood, although a possible explanation
is discussed below.
Huang and colleagues (95) have hypothesized that neuronal DMV subgroups in
the human may form functional units innervating specific organs; our studies in the
rat suggest a similar organization. Combined retrograde tracing, whole cell patch
clamp, and postrecording neuronal reconstruction techniques show a functional
and morphological correlation between DMV neurons and the peripheral target
organs that they innervate (92). Specifically, in the rat, DMV neurons projecting
to the gastric fundus have a smaller soma size and fewer dendritic branches than
neurons projecting to the corpus, duodenum, or cecum; neurons that project to the
cecum have the largest soma out of all these. Additionally, there is evidence to
support a relationship between structure and function of neurons in the rat DMV;
e.g., neurons responsive to gastric or intestinal distension can be distinguished into
separate morphological groups (96). Furthermore, these different DMV subgroups
produce different profiles of extracellular recorded action potentials. This last
observation suggests that DMV neurons engaged in different functions may possess
different membrane properties.
Indeed, several investigators have reported a large array of unevenly distributed
membrane currents in the DMV (92, 94, 97–100). Using the current clamp
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284 TRAVAGLI ET AL.

configuration, Browning et al. (92) showed that gastric-projecting DMV neurons

can be easily distinguished from intestinal-projecting DMV neurons by the charac-
teristic shape and duration of the after-hyperpolarization (AHP). That is, intestinal
projecting neurons have a much larger and slower AHP, in contrast to the smaller
and faster AHP of gastric-projecting neurons. This characteristic implies that gas-
tric DMV neurons are more prone to change membrane potential in response to
synaptic inputs than larger DMV neurons that project to other targets. This is of par-
ticular relevance, as one of the distinguishing features of DMV neurons is that they
maintain a spontaneous, slow (1–2 pulses sec−1 ) pacemaker-like activity (65, 101,
102). This pacemaker activity implies that afferent inputs altering the membrane
potential of these neurons by even a few mV, in either direction, cause dramatic
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changes to the vagal motor output (97, 103). One immediate implication is that the
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stomach, at rest, is controlled by a tonic vagal efferent outflow provided by small

gastric-projecting DMV cells, the vagal motor output of which is continuously
sculpted by impinging inputs. Conversely, larger intestinal DMV neurons need
more robust synaptic inputs to achieve the same membrane displacement. This
size principle, widely accepted for spinal motoneuron activation and recruitment
(104), states that neurons with the smallest cell bodies have the lowest threshold for
synaptic activation and, therefore, can be activated by weaker synaptic inputs. The
resting membrane potential of gastric smooth muscle is nonuniform, with a gradi-
ent from approximately –48 mV in the proximal stomach to −70 mV in the distal
stomach (105). The threshold for smooth muscle contraction is approximately
–50 mV (106). The myenteric plexus of the stomach essentially serves as a fol-
lower of vagal efferent input (107): There is a high degree of fidelity for activation of
gastric myenteric neurons by vagal efferent inputs (108). As a result, the proximal
stomach is highly sensitive to minute changes in input from either the cholin-
ergic excitatory branch or the NANC inhibitory branch of the DMV, and slight
changes in DMV activity in either division translate into dramatic effects on gastric
function.

Synaptic Connections Between the Nucleus Tractus

Solitarius and the Dorsal Motor Nucleus of the Vagus
The majority of NTS neurons do not possess pacemaker activity; their inputs onto
DMV neurons must be driven and are modulated by synaptic activity, either from
the afferent vagus, from other CNS areas, or via circulating hormones (10, 41,
53, 57, 65, 109–118). By being subject to a vast array of modulatory activity, the
synaptic connections between NTS and DMV by implication play a major role in
shaping the vagal efferent output.
There are numerous NTS neuronal phenotypes that can potentially contribute
input to the DMV and induce potent effects on vagally mediated gastric func-
tion (17, 119–134). Despite the presence of this vast array of neurotransmitters
in various NTS subnuclei, electrophysiological data show that the NTS primarily
controls the DMV through glutamatergic (37, 61, 101, 135, 136), GABAergic (61,
101, 137), and catecholaminergic (138–140) inputs. Electrical stimulation of the
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VAGAL CONTROL OF THE GI TRACT 285

NTS subnucleus commissuralis, for example, evokes noradrenergic α2-mediated

inhibitory potentials in approximately 10% of the DMV neurons (140), whereas
an α1-mediated current can be evoked by stimulation of the A2 area between
the subnuclei medialis and cNTS of the NTS (K.N. Browning & R.A. Travagli,
unpublished data). Additionally, stimulation of other portions of the NTS evokes
both inhibitory GABA-mediated or/and excitatory glutamate-mediated currents in
DMV neurons (61, 101, 103, 141–144). Pharmacological and immunocytochemi-
cal experiments have determined that GABA released onto DMV neurons activates
GABA-A receptor subtypes (101, 135, 146–148).
Most of the NTS-induced inhibition of the DMV is mediated by GABA, inter-
acting with the GABA-A receptor; conversely, most of the excitation delivered to
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the DMV by the NTS is mediated by glutamate interacting with both NMDA and
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non-NMDA receptors (101, 144, 146, 149–152). Recent data from our laboratory
show a major functional role of catecholamines (likely originating from the A2
area) in both excitatory and inhibitory control of DMV. Application of glutamate
or catecholamine agonists in the dorsal vagal complex (DVC) has profound effects
on gastric motility and tone (114, 138, 152–154). Glutamate injected into the me-
dial portion of the DMV causes a brisk gastric excitation, whereas norepinephrine
injections cause gastroinhibition, perhaps owing to the simultaneous activation of
the NANC inhibitory pathway and inhibition of the cholinergic gastroexcitatory
pathway (66, 138, 139).
Microinjections of glutamate and catecholamine antagonists in the same area,
however, do not induce noticeable effects on gastric motility and tone unless
GABAergic transmission is blocked (37, 135, 138). Conversely, microinjections of
GABA antagonists into the DVC induce profound excitatory effects on esophageal
motility and on gastric motility and secretion (135, 147, 148). Taken together, these
data suggest that the DMV output is restrained by a tonic GABAergic input aris-
ing, most likely, from the NTS. Furthermore, they suggest that factors modulating
GABAergic inputs from the NTS to the DMV may have a significant impact on
vagal reflex control of the stomach. By contrast, glutamatergic and catecholamin-
ergic inputs do not seem to play a major role in setting tonic vagal output to the
GI tract but rather seem to be invoked phasically by specific reflexes. Thus, NTS
neurons that display some type of spontaneous activity use GABA as their main
neurotransmitter. Glutamatergic and adrenergic NTS neurons are probably silent
unless activated by afferent input.

Vagal Efferent (Motor) Control

To better appreciate the role of the efferent vagus in controlling GI functions,
one has to consider the short-term effects of vagotomy (reviewed recently in Ref-
erences 9 and 155). Acute vagotomy induces an increase in fundic tone and a
decrease in antral motility, impairing the reservoir function of the stomach. The
conflicting effects of vagotomy suggested to Pavlov that the vagus nerve controlled
gastric motility through both inhibitory and excitatory pathways, a concept that
has received ample support over the past 100 years.
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286 TRAVAGLI ET AL.

The vast majority (>95%) of DMV neurons are cholinergic, i.e., choline acetyl-
transferase immunoreactive (156). Some DMV neurons also express immunoreac-
tivity for nitric oxide synthase (NOS) or catecholamines [e.g., tyrosine hydroxylase
(TH)] (89, 156–159). Although the projections of NOS- (158) or TH- (159) positive
DMV neurons target selective areas of the stomach, the physiological significance
of this detail is not clear. Interestingly, in both rodent (66, 89) as well as in feline
(160) models, these markers for alternate neurotransmitter synthesis (i.e., TH and
NOS) tend to coincide with the location of neurons involved in the inhibitory effect
of vagal input to the stomach. For example, NOS-containing DMV neurons are
found in the extreme caudal and rostrolateral portions of the DMV. Stimulation
of these areas evoke gastric relaxation (66, 89, 160). This is far from establishing
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a connection between NOS- (or TH-) positive neurons and gastroinhibition; the
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correlation, however, is quite intriguing.

Using an intact vagus-gastric myenteric plexus in vitro preparation, Schemann
& Grundy (107) demonstrated that stimulation of vagal preganglionic fibers, likely
originating from DMV somata, induces exclusively cholinergic nicotinic poten-
tials. These data indicate that acetylcholine, interacting with nicotinic receptors,
is the principal neurotransmitter released from vagal efferent terminals and that
preganglionic vagal fibers excite only enteric neurons. Because activation of vagal
efferent fibers can induce both excitatory as well as inhibitory effects on gastric
smooth muscles (18, 38, 62, 66, 160–180), it is clear that both excitatory and
inhibitory postganglionic neuroeffectors are released from enteric neurons in re-
sponse to excitatory vagal input. Note that the inhibitory vagal action on the stom-
ach is directed toward the control of motility and tone but not of gastric secretion
(181–185).
The principal excitatory postganglionic neurotransmitter is acetylcholine acting
on muscarinic receptors in gastric smooth muscle, ICC, and parietal cells. Acti-
vation of muscarinic receptors depolarize smooth muscle and the ICC to augment
the smooth-muscle activity that drives peristalsis and tone (1, 2, 4, 26, 186–190).
Inhibitory postganglionic neurons comprise the NANC path between the nico-
tinic preganglionic vagal efferent fibers and gastric smooth muscle and ICCs. The
two most likely candidates mediating this connection are nitric oxide and vasoac-
tive intestinal polypeptide, although other mediators such as adenosine and/or
serotonin (5HT) have also been implicated (84, 162, 164, 165, 169–171, 176, 179,
191–194). Activation of this vagal NANC path produces a profound relaxation of
the proximal stomach and depresses motility in the antrum. Together, these excita-
tory and inhibitory vagal efferent control mechanisms provide the brainstem with
the tools to exert a very fine control of gastric motility (10).

Vago-Vagal Reflexes
Afferent input to the NTS is organized in a distinct viscerotopic manner: The intes-
tine is represented in the subnuclei commissuralis and medialis, the stomach in the
subnuclei medialis and gelatinosus, and the esophagus in the cNTS (67–69). Elu-
cidation of this viscerotopic organization of afferent information, together with the
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VAGAL CONTROL OF THE GI TRACT 287

knowledge that the DMV may be organized in a more functional manner, led to the
hypothesis that vago-vagal reflex functions are organized in a sort of functional
matrix (82). According to this hypothesis, contributions of vagal afferent input
from different regions of the gut lead to different patterns of gut-directed vagal
efferent outflow. Accordingly, afferents serving one gut region synapse on a subset
of NTS neurons that, in turn, terminate on an appropriate collection of DMV neu-
rons, completing the reflex. Medial NTS neurons (i.e., the cells that receive vagal
afferent input from the stomach and intestine) possess long mediolaterally oriented
dendrites (∼600 μm) that extend across the terminal zones of all gastrointestinal
afferent inputs (195). A priori, such an arrangement tends to favor a convergence
of vagal afferent input of different modalities and different visceral loci onto se-
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lect populations of NTS neurons. Selected NTS neurons provide dominant local
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synaptic control over the appropriate DMV projections to the stomach (61, 82) and
determine a specific pattern of gastric control (59, 60, 108). In general, stimulation
of the proximal GI (i.e., esophagus, fundic stomach) vagal afferents activates some
gastric-projecting vagal fibers while inhibiting others. By contrast, activation of
vagal afferents from more distal sites in the antrum and intestine results in inhi-
bition of practically all vagal outflow to the stomach (see reviews in References
10, 61, 62, and 108). In combination with other physiological studies, we see that
vagal afferent input integrated by the NTS ultimately evokes gastroinhibition by
either the withdrawal of cholinergic tone (i.e., generated by the pacemaker activity
of DMV neurons), the activation of the vagal NANC pathway, or a combination
of both, as described above.
This model provides the framework for the hardware responsible for coordi-
nating vago-vagal responses. In its static form, one may presume that activation
of any given afferent elicits the same hard-wired efferent response. Recent studies
have, however, revealed a high degree of plasticity in available responses, such as
in the vago-vagal reflex control over the stomach. One agonist signal may “gate”
another, and the tonic effects of vagal afferent input may “gate” agonist responses.
As mentioned above, DMV neurons are spontaneously active and highly sensi-
tive to inputs from the NTS. This means that influences modulating NTS input to
the DMV can have potent effects on the regulation of gastric motility. Although
many examples of presynaptic modulation of the NTS are available, we focus
below on the regulation of opioidergic presynaptic signaling, as it is perhaps the
best-developed example.

Agonist and Afferent “Gating” of Opiate Effects

on Connections Between the NTS and DMV
CNS opioid release is proportional to the anticipated quality of a reward (196–198).
With respect to feeding, opioid release is associated with the expected quality of
food to be consumed. It is clear that activation of central opioidergic mechanisms
is associated with the consumption of large amounts of palatable food. In evolu-
tionary terms, rapid consumption of scarce, palatable food was desirable, in that
palatability is an excellent predictor of caloric density or metabolic usefulness.
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288 TRAVAGLI ET AL.

There is some evidence suggesting that opiates can act in the dorsal vagal complex
to augment feeding as well as to coordinate gastric function in anticipation of large
(and in evolution, scarce) palatable meals (199–201). It would be advantageous,
under these circumstances, to have a “cephalic-phase” mechanism by which opi-
oids could augment digestive processes in order to assimilate high-quality food as
quickly as possible. It would be especially convenient if the effects of opioids to
accelerate digestion could be gated or regulated by the presence of other agonists
whose release would signal either imminent feeding or that feeding is taking place.
In this way, the effects of opioids on digestion would work best while taking food
rewards, but not during the taking of other rewards.
Activation of central opioid receptors, abundant also in the DVC, may signal the
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consumption of palatable food and elicit gastric relaxation (199, 200, 202–208).
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Enhancement of proximal gastric relaxation during feeding would assist in the

assimilation of large, palatable meals. Teleologically speaking, such a mechanism
would explain why celebrants at Thanksgiving dinner may complain that they
can’t eat another bite of green beans, yet mysteriously “find room” for pie and ice
cream. Although this laboratory group did not set out specifically to investigate
the hedonic mechanism of gastric relaxation in response to palatable meals, our
basic neurophysiological results do suggest that opioid effects within the DVC to
provoke gastric relaxation are gated by factors associated with the taking of meals.
When we analyzed the cellular mechanisms of μ-opioid actions in the DVC, our
group first showed that endogenous opioid peptides inhibit all of the glutamatergic
but none of the GABAergic currents between the NTS and the DMV (141). The
selectivity of the effects of opioids on the brainstem circuitry was explained by the
presence of μ-opioid receptors on the surface of glutamatergic, but not GABAer-
gic, profiles impinging on DMV neurons (141) (Figure 2). It is possible, however,
to induce an inhibitory effect of opioids on approximately 60% of the GABAergic
currents by activating the cAMP-PKA pathway either via forskolin or via pretreat-
ment with hormones such as thyrotropin-releasing hormone (TRH) or CCK. TRH
and CCK are well-known markers of cephalic-phase digestive functions (10, 209)
and the consumption of fatty meals, respectively (210).
The increase in cAMP-PKA activity in NTS neurons promotes fast (within five
minutes) but short-lasting (approximately 60 minutes) trafficking of μ-opioid re-
ceptors from intracellular compartments to the outer membrane of the GABAergic
terminals. Once on the surface of the synaptic terminal, opioid receptors are avail-
able for activation by the μ-agonist, resulting in a decrease in the net charge of the
GABAergic current (211). This mechanism may explain, in part, feeding-related
changes in the effectiveness of central gastroinhibitory action of opiates. Opioid
receptors are normally available for interaction with their endogenous ligand on
a limited population of glutamatergic synapses impinging on DMV neurons of
the cholinergic (gastroexcitatory) pathway. Inhibition of this glutamatergic input
induces a partial cholinergic withdrawal in the stomach and, by consequence, a
modest inhibition of gastric motility. Activation of the cAMP-PKA pathway in
the NTS, for example by peptides such as TRH or CCK, induces trafficking of
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VAGAL CONTROL OF THE GI TRACT 289

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Figure 2 Differential modulation of synaptic transmission. Depiction of the synaptic con-

nections between the NTS and the DMV. (A) Under control conditions, the μ-opioid receptor
(μ) is expressed on the nerve terminal of glutamatergic NTS profiles apposing DMV neurons;
by contrast, on GABAergic nerve terminals, the μ-opioid receptor is internalized and asso-
ciated with the Golgi apparatus (upper panel). Opioid agonists (e.g., Enk) can act to inhibit
glutamate synaptic transmission, but not GABAergic transmission (lower panel). (B) High-
power photomicrographs of the cloned μ-opioid receptor (MOR1)-immunoreactivity (-IR;
TRITC filters, red) and γ-glutamyl glutamate-IR (Glu-IR; FITC filters, green; left panel)
used as a marker for glutamate nerve terminals, and glutamic acid decarboxylase-IR (GAD-
IR; FITC filters, green; right panel) used as a marker for GABAergic nerve terminals in
the rat DVC. Note that MOR1-IR is colocalized with glutamate nerve terminals (yellow;
arrows) but not with GABA nerve terminals. Scale bar: 15 μm. (C) Representative traces of
evoked excitatory postsynaptic currents (eEPSCs) (left panel) and evoked inhibitory postsy-
naptic currents (eIPSCs) (right panel) in gastric-projecting DMV neurons voltage-clamped at
–60 mV and –50 mV, respectively, evoked by electrical stimulation of the NTS. Perfusion
with Enk inhibits the eEPSCs but not eIPSCs. Scale bar: 50 pA and 30 ms.

μ-opioid receptors on GABA terminals synapsing on DMV neurons that comprise

the NANC pathway (211). Opioid agonists, by reducing the GABAergic input to
these DMV neurons, increase the vagal output of NANC neurotransmitters to the
target organ and, by consequence, further enhance its inhibition. By this means, the
effectiveness of opiates to provoke gastroinhibition can be greatly amplified by the
action of other agonists.
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290 TRAVAGLI ET AL.

Agonist modulation of receptor trafficking may also be responsible for the dra-
matic and very different effects neuropeptide Y (NPY) has on gastric motility in the
fed versus fasted state. Briefly, a vagally mediated increase in gastric motility and
secretion is observed when NPY is administered centrally to fasted rats (212, 213),
but gastric motility is reduced when NPY is administered to fed rats (213, 214).
The cellular explanation of this intriguing difference in gastric responses to cen-
tral administration of NPY is probably similar to those explanations regarding the
effects of opioids at the level of the GABAergic synapse between the NTS and the
DMV (62, 141, 143, 211, 215). Our group has shown recently that the GABAergic
NTS synapse with DMV neurons is subject to receptor trafficking modulation by
a number of neurotransmitter and hormone agonists, including TRH, CCK, 5HT,
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

norepinephrine, pancreatic polypeptides, and opiates (103, 211, 216–221).

by Lomonosov Moscow State University on 02/10/14. For personal use only.

In another hypothesis, an additional type of short-term plasticity, determined

by the state of activation of vagal afferent fibers, also influences receptor avail-
ability at the level of the DMV-NTS GABAergic synaptic connection. This, in
turn, allows the vago-vagal reflex circuits to adapt their responses to the imme-
diate physiological needs of the animal, i.e., to different phases of the digestive
process. As mentioned above, this hypothesis is quite appealing because it sug-
gests that multiple factors regulating the release of glutamate from vagal afferents
(e.g., CCK, leptin, tumor necrosis factor, and glutamate itself) may modulate basic
reflex functions.
Preliminary data from our group are starting to provide explanations for the
cellular and structural mechanisms that underlie the capability of this circuit to
adapt its responses to the visceral afferent state of activation. Although this state
of activation is reflected in the levels of activity of the cAMP-PKA pathway in the
GABAergic NTS nerve terminals impinging on DMV neurons, it is set, princi-
pally, by vagal afferent fiber inputs onto NTS neurons and/or terminals. We came
to this conclusion by observing that following vagal sensory deafferentation, ei-
ther by perivagal capsaicin or by selective sensory rhizotomy, opioids reduced the
GABAergic currents between the NTS and the DMV, but without the need for in-
creasing the activity of the cAMP-PKA pathway (215). These data imply that vagal
sensory afferent inputs chronically dampen the level of activity of the cAMP-PKA
pathway at the level of the GABAergic synapses between the NTS and the DMV,
making the synapse unavailable for modulation. As mentioned above, glutamate is
the main neurotransmitter of vagal afferent fibers impinging on brainstem circuits
(32–35, 37–42, 44, 45). Following its release, glutamate activates both ionotropic
and metabotropic receptors (mGluRs). All metabotropic glutamate receptor sub-
units identified to date have been found in the DVC (50). The presence of group II
and III mGluRs, both of which play a role in the modulation of brainstem vagal cir-
cuits (47–49, 222, 223), is of particular interest, because their activation decreases
the levels of cAMP (224). We have recently investigated whether these receptor
groups are involved in setting the levels of cAMP-PKA activation in GI brainstem
circuits and, by consequence, in determining the availability of the NTS-DMV
GABAergic synapse to modulation.
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VAGAL CONTROL OF THE GI TRACT 291

Our data indicate that group II mGluRs, but not group III mGluRs, are in-
volved in this type of modulation of the GI brainstem circuits. In fact, pretreat-
ment with selective mGluR group II antagonists “primes” the μ-opioid receptors
on GABAergic NTS-DMV synapses, making it possible for opioids to modulate
the inhibitory currents without the need to pharmacologically increase the activ-
ity of the cAMP-PKA pathway (K.N. Browning, Z.L. Zheng, & R.A. Travagli,
submitted manuscript).
In summary, sensory vagal afferent fibers use group II mGluRs to dampen the
activity of the cAMP-PKA pathway in GABAergic NTS nerve terminals. While
held in check, the low levels of cAMP-PKA activity keep the μ-opioid receptors in
inaccessible intracellular compartments such that enkephalins do not have a mod-
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

ulatory effect on the NTS-DMV GABAergic currents. The use of glutamate both
by Lomonosov Moscow State University on 02/10/14. For personal use only.

to activate the sensory vagal pathways and at the same time keep the GABAer-
gic NTS neurons in a nonmodulatory state is an apparent conundrum. In fact, it
implies that glutamate released by sensory vagal afferent fibers exerts opposite
functions via simultaneously acting at ionotropic receptors (which carry informa-
tion about the visceral organs and prepare the circuit for a sophisticated level of
modulation to allow the appropriate response) and at mGluRs (which dampen the
brainstem GABAergic circuitry and prevent its modulation by neurotransmitters
such as pancreatic polypeptides, opioids, indolamines, and catecholamines).
We have to keep in mind, however, that group II mGluRs may be located perisy-
naptically (225) and may be activated by the release of glutamate that leaks from
vagal afferent terminals on NTS neurons in an action potential–independent man-
ner. If this is the case, then mGluRs and ionotropic glutamate receptors may coexist
without interfering with each others’ functions; furthermore, peptides impinging on
NTS neurons, such as TRH and CCK, that increase the activity of the cAMP-PKA
pathway may overcome the tonic activation of group II mGluRs, increase the
levels of cAMP, and induce altered sensitivity of neural circuits to a variety of in-
puts. The role of glutamate activation of group II mGluR, then, may be to change
the synaptic state of the NTS-DMV GABAergic circuit. The widespread use by
different neurotransmitters of the cAMP-PKA pathway argues in favor of its uti-
lization in a general manner in the control of vago-vagal circuits. Also, depend-
ing on whether the affected GABAergic NTS-DMV synapse controls cholinergic
excitatory pathways or NANC inhibitory pathways, a decrease in synaptic trans-
mission may result in an increased or decreased vagal motor output, respectively.
The physiological correlate of these experimental conditions is modulation of the
NTS-DMV GABAergic synapse by neurotransmitters that are coupled to adeny-
late cyclase and that generate cAMP. Alterations in sensory inputs from the GI
tract, such as those following activation of vago-vagal reflexes or changes in the
feeding status, for example, are expected to modify the ability of tonic GABAer-
gic inputs controlling the vagal brainstem circuits to be modulated. For example,
the constant perception of ongoing GI tract activity exerts a tonic inhibition of
cAMP-PK pathways in the DVC. Activation of vago-vagal reflexes or changes
in the state of activation (i.e., from fasted to fed or vice versa) may change the
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292 TRAVAGLI ET AL.

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by Lomonosov Moscow State University on 02/10/14. For personal use only.

Figure 3 Increasing the levels of cAMP in the brainstem induces receptor trafficking in NTS
nerve terminals. (A) In control conditions, i.e., when the levels of cAMP are low either because
the tonic release of glutamate from vagal afferent fibers activates group II metabotropic gluta-
mate receptors (left) or because Gαs-coupled receptors are not activated (right), the terminals
of GABAergic neurons in the NTS store μ-opioid receptors (μ) in internal compartments
associated with the Golgi complex. In this situation, μ-opioid agonists (e.g., Enk) cannot
modulate the release of GABA onto DMV neurons. (B) Following increases in cAMP levels
within the GABAergic nerve terminal, for example, by (1) activation of a receptor coupled
to Gαs e.g., TRH or CCK, (2) antagonism of group II metabotropic glutamate receptors, or
(3) removal of tonic vagal afferent input, μ-opioid receptors are released from the Golgi ap-
paratus and translocated to the nerve terminal membrane, where opioid agonists can inhibit
GABA synaptic transmission between the NTS and the DMV. (C) High-power photomi-
crographs of the cloned μ-opioid receptor (MOR1)-immunoreactivity (-IR; TRITC filters,
red) and glutamic acid decarboxylase-IR (GAD-IR; FITC filters, green) used as a marker for
GABAergic nerve terminals in the rat DVC. In control conditions (left panel), note the absence
of MOR- and GAD-IR colocalized profiles. Following vagal afferent rhizotomy (right panel),
many nerve terminals show MOR- and GAD-IR colocalized profiles (yellow; arrows). Images
represent three-dimensional reconstructions from Z-stack image series. Scale bar: 10 μm.
(D) Representative traces of eIPSCs evoked in a gastric-projecting DMV neuron voltage-
clamped at –50 mV. Perfusion with Enk does not affect the amplitude of IPSCs evoked by
electrical stimulation of the NTS. Following five minutes’ perfusion with substances that in-
crease the cAMP levels, however, reapplication of Enk reduces the amplitude of the eIPSCs.
Scale bar: 50 ms and 200 pA.
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VAGAL CONTROL OF THE GI TRACT 293

levels of cAMP and influence the ability of circulating hormones or locally released
neurotransmitters to modulate inhibitory synaptic transmission between the NTS
and the DMV (Figure 3).

SUMMARY
GI brainstem circuits that are part of vago-vagal reflexes are comprised of sensory
afferent fibers whose terminals impinge on NTS neurons. The NTS neurons then
project to DMV cells, which in turn provide the preganglionic efferent fibers
controlling cholinergic excitatory and NANC inhibitory postganglionic cells. The
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

strategic location outside the blood-brain barrier of portions of brainstem vagal

by Lomonosov Moscow State University on 02/10/14. For personal use only.

circuits makes them accessible to a multitude of circulating hormones, cytokines,

and chemokines that can dramatically alter vago-vagal reflex responsiveness. Add
to this the dense and phenotypically diverse descending projections from anterior
forebrain structures to the dorsal vagal complex (8), and it becomes clear that the
number of mechanisms by which vago-vagal reflex selectivity and sensitivity can
be modulated is virtually limitless.
The presynaptic modulation, and hence plasticity, of these circuits allows for a
finely tuned control over gastric functions. It is now apparent that these circuits are
not static entities devoted to the relay of unprocessed information between the brain
and the gut. Indeed, by controlling the levels of activity of the cAMP-PKA pathway
in synaptic terminals, circulating molecules, descending neurotransmitter inputs,
and primary afferent traffic can act on brainstem circuits to affect the sensitivity
of the synapses to modulation. If variations of the cAMP levels are determined,
for example by the substances circulating in different situations such as during
fasting or following a meal or by differing levels of visceral afferent traffic, then
the net effect of activation of a particular circuit can vary according to the cAMP
levels within the synapse itself. This implies, then, that gross differences in the
performance of gastric control reflexes that occur at different times of the digestive
process may result from variations in the cAMP levels at GABAergic NTS-DMV
synapses.
In conclusion, we are just starting to understand the cellular mechanisms that
underlie the exquisite coordination of digestive processes with ongoing and antic-
ipated changes in behavior as a consequence of the diversity of input. The work to
be conducted in the years to come must investigate the circulating factors that can
cause rapid changes in brain-gut control through their direct action on brainstem
vagal reflex control circuits and the cellular entities involved in this control. A mul-
titude of possible modulatory mechanisms exist within these circuits to guarantee
speed, precision, and flexibility in the control of digestive processes.

ACKNOWLEDGMENTS
The authors would like to thank the NIH (grants nos. DK-55530, DK-56373, and
DK-52142) and NSF (grant no. IBN-0456291) for their support. We also thank
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294 TRAVAGLI ET AL.

Cesare M. Travagli, Hans Hermann, and Lois and Richard F. Rogers for their
support and encouragement.

The Annual Review of Physiology is online at

http://physiol.annualreviews.org

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Annual Review of Physiology

Volume 68, 2006

CONTENTS
Frontispiece—Watt W. Webb xiv
PERSPECTIVES, David L. Garbers, Editor
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

Commentary on the Pleasures of Solving Impossible Problems

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of Experimental Physiology, Watt W. Webb 1

CARDIOVASCULAR PHYSIOLOGY, Jeffrey Robbins, Section Editor
Cardiac Regeneration: Repopulating the Heart, Michael Rubart
and Loren J. Field 29
Endothelial-Cardiomyocyte Interactions in Cardiac Development
and Repair, Patrick C.H. Hsieh, Michael E. Davis,
Laura K. Lisowski, and Richard T. Lee 51
Protecting the Pump: Controlling Myocardial Inflammatory Responses,
Viviany R. Taqueti, Richard N. Mitchell, and Andrew H. Lichtman 67
Transcription Factors and Congenital Heart Defects, Krista L. Clark,
Katherine E. Yutzey, and D. Woodrow Benson 97
CELL PHYSIOLOGY, David L. Garbers, Section Editor
From Mice to Men: Insights into the Insulin Resistance Syndromes,
Sudha B. Biddinger and C. Ronald Kahn 123
LXRs and FXR: The Yin and Yang of Cholesterol and Fat Metabolism,
Nada Y. Kalaany and David J. Mangelsdorf 159
ECOLOGICAL, EVOLUTIONARY, AND COMPARATIVE PHYSIOLOGY,
Martin E. Feder, Section Editor
Design and Function of Superfast Muscles: New Insights into the
Physiology of Skeletal Muscle, Lawrence C. Rome 193
The Comparative Physiology of Food Deprivation: From Feast to Famine,
Tobias Wang, Carrie C.Y. Hung, and David J. Randall 223
Oxidative Stress in Marine Environments: Biochemistry and
Physiological Ecology, Michael P. Lesser 253
GASTROINTESTINAL PHYSIOLOGY, John Williams, Section Editor
Brainstem Circuits Regulating Gastric Function, R. Alberto Travagli,
Gerlinda E. Hermann, Kirsteen N. Browning, and Richard C. Rogers 279

vii
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January 18, 2006 10:52 Annual Reviews AR265-FM

viii CONTENTS

Interstitial Cells of Cajal as Pacemakers in the Gastrointestinal Tract,

Kenton M. Sanders, Sang Don Koh, and Sean M. Ward 307
Signaling for Contraction and Relaxation in Smooth Muscle of the Gut,
Karnam S. Murthy 345
NEUROPHYSIOLOGY, Richard Aldrich, Section Editor
CNG and HCN Channels: Two Peas, One Pod, Kimberley B. Craven
and William N. Zagotta 375
RENAL AND ELECTROLYTE PHYSIOLOGY, Gerhard H. Giebisch, Section Editor
Claudins and Epithelial Paracellular Transport, Christina M. Van Itallie
Annu. Rev. Physiol. 2006.68:279-305. Downloaded from www.annualreviews.org

and James M. Anderson 403

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Role of FXYD Proteins in Ion Transport, Haim Garty

and Steven J.D. Karlish 431
Sgk Kinases and Their Role in Epithelial Transport, Johannes Loffing,
Sandra Y. Flores, and Olivier Staub 461
The Association of NHERF Adaptor Proteins with G Protein–Coupled
Receptors and Receptor Tyrosine Kinases, Edward J. Weinman,
Randy A. Hall, Peter A. Friedman, Lee-Yuan Liu-Chen,
and Shirish Shenolikar 491
RESPIRATORY PHYSIOLOGY, Richard C. Boucher, Jr., Section Editor
Stress Transmission in the Lung: Pathways from Organ to Molecule,
Jeffrey J. Fredberg and Roger D. Kamm 507
Regulation of Normal and Cystic Fibrosis Airway Surface Liquid Volume
by Phasic Shear Stress, Robert Tarran, Brian Button,
and Richard C. Boucher 543
Chronic Effects of Mechanical Force on Airways, Daniel J. Tschumperlin
and Jeffrey M. Drazen 563
The Contribution of Biophysical Lung Injury to the Development
of Biotrauma, Claudia C. dos Santos and Arthur S. Slutsky 585
SPECIAL TOPIC, TRP CHANNELS, David E. Clapham, Special Topic Editor
An Introduction to TRP Channels, I. Scott Ramsey, Markus Delling,
and David E. Clapham 619
Insights on TRP Channels from In Vivo Studies in Drosophila,
Baruch Minke and Moshe Parnas 649
Permeation and Selectivity of TRP Channels, Grzegorz Owsianik,
Karel Talavera, Thomas Voets, and Bernd Nilius 685
TRP Channels in C. elegans, Amanda H. Kahn-Kirby
and Cornelia I. Bargmann 719